Measles is not a very pleasant disease, highly contagious and..., alas, not only for children. Adults, even those vaccinated in childhood, can also easily catch it. Expectant mothers also need to be attentive, especially those who already have schoolchildren and preschoolers - first of all, children who attend kindergartens are at risk for leisure-time illnesses because, having been ill, a person acquires stable lifelong immunity. “Since 2010, there has been an increase in the incidence of measles (as a rule, the increase occurs in the autumn-winter period). Measles is very contagious, the virus is volatile, so it can easily move through ventilation shafts and then the entire entrance is “contact”.
But it gives stable lifelong immunity (after vaccination, immunity lasts 15-20 years). During the period of rising incidence, both vaccinated and unvaccinated children can get sick,” explains pediatrician Yulia Viktorovna Andronnikova, head of the pediatric department of the Territory of Health and author of a lecture on the feasibility and safety of vaccination.
Manifestations
21 days is how long the measles virus can sit in the body without manifesting itself. But most often the disease makes itself felt after 7 days, in the second week of infection. Measles begins in the same way as a regular ARVI: not with the characteristic rashes, but with a runny nose, sore throat, cough, conjunctivitis and high fever. Therefore, for the first 2-3 days you need to carefully monitor the oral mucosa - the FIRST typical manifestation of measles is small white spots, most often on the cheeks in the area of the molars. On the 4-5th day of illness, against the background of the same high temperature, a rash already appears: 1st day - face (behind the ears, on the bridge of the nose, on the cheeks), 2nd day - on the arms and torso, 3rd day - on my feet. The rash also goes away gradually, leaving brown pigmentation. You can become infected from a child from the appearance of the first symptoms of the disease (before the rash!) and another 5 days from the moment the rash appears.
Measles
Credits : World Health Organization
Newsletter N°286
February 2015
Key Facts
- Measles is a leading cause of death among young children, even with the availability of a safe and effective vaccine.
- Globally, there were 145,700 measles deaths in 2013—almost 400 per day or 16 per hour.
- Between 2000 and 2013, measles vaccination led to a 75% reduction in global measles deaths.
- In 2013, about 84% of all children worldwide received one dose of measles vaccine during their first year of life as part of routine health care, up from 73% in 2000.
- In 2000-2013 Measles vaccination has prevented an estimated 15.6 million deaths, making measles vaccine one of the most beneficial public health advances.
Measles is a highly contagious, severe disease of viral origin. In 1980, before widespread vaccination, there were an estimated 2.6 million deaths from measles.
Measles remains a leading cause of death among young children worldwide, even with the availability of a safe and effective vaccine. An estimated 145,700 people died from measles in 2013, most of them children under 5 years of age.
The causative agent of measles is a virus from the paramyxovirus family. The measles virus is usually transmitted through direct contact and also through the air, infecting the mucous membranes and then spreading throughout the body. Measles is a human disease and has not been reported in animals.
Accelerated immunization efforts have had a significant impact on reducing measles deaths. In 2000-2013 Measles vaccination prevented an estimated 15.6 million deaths. Global measles deaths fell by 75%, from 544,200 deaths in 2000 to 145,700 deaths in 2013.
Signs and symptoms
The first sign of measles is usually a significant increase in temperature, which occurs approximately 10 to 12 days after exposure to the virus and lasts for 4 to 7 days. During this initial stage, a runny nose, cough, red and watery eyes, and small white patches on the inner cheeks may appear. After a few days, a rash appears, usually on the face and upper neck. After about 3 days, the rash spreads throughout the body and eventually appears on the arms and legs. It lasts 5-6 days and then disappears. On average, the rash appears 14 days (range 7 to 18 days) after exposure to the virus.
Most measles deaths occur due to complications associated with the disease. Most often, complications develop in children under five years of age or in adults over 20 years of age. The most serious complications include blindness, encephalitis (an infection that causes swelling of the brain), severe diarrhea and associated dehydration, ear infections, and severe respiratory tract infections such as pneumonia. Severe measles is more likely among poorly nourished young children, especially those who are deficient in vitamin A or whose immune systems are weakened by HIV/AIDS or other diseases.
In populations with high levels of malnutrition and lack of adequate medical care, up to 10% of measles cases are fatal. Infected women are also at risk of developing severe complications during pregnancy, and pregnancies may end in spontaneous abortion or premature birth. People who have had measles develop immunity against it for the rest of their lives.
Who is at risk?
Unvaccinated young children are at highest risk of measles disease and complications, including death. Unvaccinated pregnant women are also at risk. Anyone who is not immune can become infected with measles - someone who has not been vaccinated or someone who has not developed immunity after being vaccinated.
Measles is still widespread in many developing countries - especially in parts of Africa and Asia. More than 20 million people become ill with measles every year. The vast majority (more than 95%) of measles deaths occur in countries with low per capita income and weak health infrastructures.
The deadliest measles outbreaks occur in countries experiencing natural disasters and conflict, or returning to normal after such events. Damage to infrastructure and health services disrupts routine immunizations, and overcrowded residential camps significantly increase the risk of infection.
Transmission of infection
The highly contagious measles virus is spread by coughing and sneezing, close personal contact, or direct contact with infected nasopharyngeal secretions.
The virus remains active and contagious in the air or on infected surfaces for 2 hours. It can be transmitted by an infected person over a period of time starting 4 days before the rash appears and ending 4 days after it appears.
Measles outbreaks can take the form of epidemics, causing many deaths, especially among malnourished young children.
In countries where measles has been largely eliminated, cases imported from other countries remain a significant source of infection.
Treatment
There is no specific treatment against the measles virus. Severe complications of measles can be avoided with supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solutions. These solutions replace fluid and other important micronutrients that are lost due to diarrhea and vomiting. Antibiotics should be prescribed to treat eye and ear infections and pneumonia.
All children in developing countries who are diagnosed with measles should receive 2 doses of a vitamin A supplement, given 24 hours apart. This treatment restores the low levels of vitamin A seen during measles, even among well-nourished children, and may help prevent eye damage and blindness. Vitamin A supplements have been shown to reduce measles deaths by 50%.
Prevention
Regular measles vaccination of children, combined with mass immunization campaigns in countries with high morbidity and mortality rates, are the main public health strategies to reduce global measles mortality. The measles vaccine has been used for 50 years. It is safe, effective and inexpensive. Immunizing one child against measles costs approximately US$1.
Measles vaccine is often combined with rubella and/or mumps vaccines in countries where these diseases are a problem. It is equally effective both as a single vaccine and in a combined form. The inclusion of rubella in the measles vaccine only slightly increases its cost and allows the costs of vaccine delivery and vaccination to be combined.
In 2013, about 84% of all children worldwide received 1 dose of measles vaccine during their first year of life as part of routine health care, up from 73% in 2000. To provide immunity and prevent outbreaks, 2 doses of the vaccine are recommended because approximately 15% of vaccinated children do not develop immunity after the first dose.
WHO activities
The fourth Millennium Development Goal (MDG 4) aims to reduce under-5 mortality by two-thirds over the period 1990-2015. Based on recognition of the potential of measles vaccination to reduce child mortality, and given the fact that coverage can be considered an indicator of access to children's health services, routine measles vaccination coverage was selected as an indicator of progress towards achieving MDG 4.
Extensive evidence demonstrates the benefits of achieving universal access to measles and rubella vaccines. Reducing mortality from measles is a major contributor to the reduction in overall under-5 mortality and progress towards MDG 4. An estimated 544,200 children worldwide died from measles in 2000. By 2013, a global initiative to improve vaccination coverage led to a 75% reduction in deaths. Between 2000 and 2013, supported by the Measles and Rubella Initiative (MRI), measles vaccination prevented an estimated 15.6 million deaths. In 2013, approximately 205 million children were vaccinated against measles in mass vaccination campaigns carried out in 34 countries.
With the adoption by Member States of the South-East Asia Region of the goal of eliminating measles by 2021, all WHO regions have set goals to eliminate this preventable killer disease. WHO and its partners are committed to helping Member States achieve their goals. The Measles and Rubella Initiative is a joint effort of WHO, UNICEF, the American Red Cross, the United States Centers for Disease Control and Prevention and the United Nations Foundation to support countries in achieving their measles and rubella control goals.
In 2012, the Measles and Rubella Initiative introduced a new Global Strategic Plan for Measles and Rubella Control, covering the period 2012–2020. The plan includes new global goals for 2015 and 2021:
By the end of 2015
- reduce global measles deaths by at least 95% compared to 2000 levels;
- achieve regional targets for measles and rubella/congenital rubella syndrome (CRS) control.
By the end of 2021
- eliminate measles and rubella in at least 5 WHO regions.
The strategy is aimed at implementing 5 main components:
- ensure and maintain broad coverage of 2-dose measles and rubella vaccines;
- monitor the disease using effective surveillance and evaluate program efforts to ensure the progress and positive impact of vaccination efforts;
- ensure and maintain outbreak preparedness, rapid response to outbreaks and effective treatment of cases of disease;
- provide information and promote participation to build public confidence in immunization and ensure public uptake for immunization;
- conduct research and development necessary to support cost-effective activities and improve vaccination and diagnostic techniques.
Implementation of the Strategic Plan can quickly and sustainably help protect and improve the lives of children and their mothers around the world. The plan provides clear strategies for country-level immunization leaders working with domestic and international partners to achieve the 2015 and 2021 goals. in the field of measles and rubella control and elimination. It builds on decades of experience in immunization program implementation and lessons learned from fast-track measles and polio eradication initiatives.
Based on current trends and performance, global immunization experts have concluded that the 2015 measles and elimination targets will not be met on time. Resuming progress will require countries and immunization partners to increase the urgency of measles elimination, remove barriers to measles vaccination, and ensure significant and sustained additional investment in strengthening health systems and achieving equitable access to immunization services.
Source
published 31/03/2014 12:40 updated 11/03/2015 — Vaccination, Infectious diseases, Vaccination, Infectious diseases, WHO materials
Prevention
It is advisable, if possible, to limit contacts: in addition to public places, in the high-risk zone there are kindergartens, centers, entertainment centers (and, first of all, children's hospitals, where you should not go even for specific examinations). It is necessary to ventilate the room as often as possible (at least 30 minutes) and try to do at least light wet cleaning a couple of times a day. But the most important thing, of course, is the functioning of the immune system. In addition to hardening, frequent walks in the fresh air, it is possible to take pre- and probiotics (KIP, “Rioflora Immuno”): both of them - they work better “in pairs”. Pre and probiotics can also be present in the daily diet if you reduce sweets, refined fats and fast carbohydrates, and give preference to fermented milk products, vegetables, fruits (and dried fruits!), and also grains. Well, make sure there is no constipation.
Of course, the most common way to prevent measles is vaccination. “When deciding to vaccinate, it is important to decide whether we are ready to get sick in order to get lasting immunity, or whether we will choose immunity for 15-20 years, which the vaccine will provide. Vaccination during the incubation period (if the measles virus has already entered the body) will not lead to an exacerbation of the disease. Antibodies to measles appear within 10-14 days, and are finally formed 1 month after vaccination” (Yu.V. Andronnikova).
Treatment of measles in children and adults
There are no methods for treating measles; doctors have to rely on the patient’s own strength. The best way to speed up your recovery and prevent complications is to drink plenty of fluids and get plenty of rest.
Antipyretics, such as paracetamol, ibuprofen, or naproxen, relieve fever and malaise. Don't give children aspirin!
Vitamin A: Children with low vitamin A levels are at higher risk of measles. Increasing its levels may reduce the severity of measles symptoms.
Drink plenty of fluids to replace fluids lost through fever and sweat. Use a humidifier to make breathing easier. Dim the lights or wear sunglasses to relieve eye pain caused by bright light.
Preventing measles
Of course, vaccination is the best way to prevent the spread of measles. The measles vaccination is 97% effective after two doses and is one of the most important in the National Preventive Vaccination Schedule, administered twice, at 1 year and at 6 years.
The vaccine is safe for most people. But pregnant women, people with weakened immune systems (due to diseases such as leukemia and tuberculosis) and people with some severe allergies should not get the vaccine—their protection against measles depends on how responsibly other people get vaccinated.
Author:
Butriy Sergey Alexandrovich pediatrician
Complications of measles
Approximately one in four people with measles requires active hospital treatment. Children under 5 years of age and adults over 20 years of age tend to have the most severe disease.
Complications of measles are:
- middle ear infections (otitis) - this is a very common complication caused by bacteria, the path for which is paved by the measles virus, sometimes such otitis causes irreversible hearing loss;
- bronchitis, laryngitis or false croup - often the measles virus causes inflammation in the voice box or bronchi, the airways leading to the lungs;
- diarrhea - every tenth person with measles suffers from diarrhea;
- viral pneumonia - severe total damage to the interstitial tissue of the lungs;
- encephalitis - a brain infection that can cause deafness and brain damage, affects about one in 1,000 people who get it, and can occur immediately or several months after infection;
- problems with pregnancy (low birth weight of the baby, premature birth or even death of the mother);
- subacute sclerosing panencephalitis is a very rare complication that occurs in some people 7–10 years after measles, affects the central nervous system and is inevitably fatal.
